KASAMA Vol. 26 No. 3 / July-August-September 2012 / Solidarity Philippines Australia Network

Universal Health Care Coverage for All is Possible and Necessary

Paper delivered at the Third People's Health Assembly, 8 July 2012, Capetown, South Africa by Dr Sylvia Estrada Claudio, MD, PhD

Dr Sylvia Estrada Claudio, MD, PhD

At the outset, I wish to note that I and some others here, are from another movement. We are from the women's movement, particularly the sexual and reproductive health and rights movement. I therefore thank the leaders of the People's Health Movement (PHM) for inviting me here. I am convinced that only a broad movement of peoples will end the discourse of profit-making that is our common enemy. I am sincere in my desire to be with the PHM as an individual activist and as someone who has led and continues to lead organizations at the grassroots and international levels.

I cannot overemphasize my solidarity with the PHM, because I am now going to talk from my heart about what bothers me, as any comrade would and should.

In the course of our Third People's Health Assembly, I have heard many things that I disagree with. I shall start on one point because it is important to my message of cross-movement solidarity. I have heard it said that we need unity and a singular line of analysis in order to win. I say, NO. Indigenous peoples, women, lesbian, gay, bisexual, transgender and intersex people, people of lower castes and classes, people of other races — have always been at the sacrificial end to this call for unity whether it be in the name of nation, religion, moral or ideological purity.

I say that this is capitalist obfuscation. Diversity is not an unfortunate matter to be managed. Diversity comes from our infinite desires and creativity. This is our boundless resource that the regime of capitalist accumulation would wish to control and harness. One need only to listen to the call of the indigenous peoples about how nature in all its diverse forms is the only reality and the only way to a full life. If nature shows us this diversity we must love it and grasp it among ourselves.

No, my friends, I am not afraid of the controversial nature of the demand for safe and legal abortion; I am not afraid of the demand of the LGBTIQ and women's movements for sexual rights; I am not afraid of the call that health care, if it is to be comprehensive, must include a full range of sexual and reproductive health services. I am not even afraid that people would disagree within the People's Health Movement. What I am afraid of is that these differences become silenced among us — as if only the voices of a few birds can sing in our forests. Let these differences come forth and stand. Rather that, than hear only the death song of capitalist hegemony.

Let me be clear. Universal health care access, not just coverage, is possible now for the majority of the world's people. What is standing in its way are not real obstacles like the lack money or infrastructure or personnel. What is standing in its way is capitalist profit-making, and the need to ensure that profit-making, by establishing an ideological hegemony. This ideological hegemony would have us accept that certain sectors have far more privilege over their material wealth, their bodies, their pleasures and their claims to human identity.

Allow me to talk about the Philippines. Our latest total health expenditures as a nation is a measly 7 billion dollars, give or take. This is the total amount Filipinos spent on health care including reproductive health care. Clearly the system can be rationalized as much of our health spending is irrational. But savings from rationalization could be used towards strengthening the health care system so that it can meet a large unmet need. This amount is less then one percent of what we continue to pay the banks to pay debts incurred by politicians more concerned with their own form of wealth accumulation than with our well-being. It is small change compared to the trillions lost in the latest financial crisis. A single system of health care with minimal or no cost at point of access is entirely possible for the Philippines. Why should it be impossible for others? Why demand less?

Universal Health Care Access is an anti-capitalist project, but it also is an anti-patriarchal one. At its very inception capitalism has imposed regimes of bodily and sexual control, as much as it has imposed regimes of production and profit extraction. Woman, man, youth, LGBTI, dalit, black, Huaorani — all these are capitalist imposed identities just as much as class. The very idea that economics is about rational and competitive man instead of desiring and nurturing woman is a myth fostered on us by the gurus of neoliberal economics.

It strikes me that the work of care, the birthing of children, the reproduction of labor power through activities of social reproduction — have been ignored by neoliberal economists and Marxist ones as well. It is clear that capitalism would have us believe that reproduction is secondary to production, so that it can continue to super-exploit the nurturing work mostly done by women. It is not clear to me why progressive economists and people's movements should believe this as well.

The rise of globalized financial capital makes the exploitation of reproductive labor even more obvious. Globalization cannot be grasped and opposed by those who would blind themselves to its gendered nature.

Capitalism has saved itself from the crisis of the overproduction of material goods by extracting profit from social reproduction at a rapid pace. Look at our mobile phones. At the very moment of your desire to communicate to a comrade, colleague or loved one — capitalism will make a profit. Just press the send button. May I remind you that the cost it takes to manufacture your phone is a pittance compared to its price. The manipulation of your desires has become crucial to capitalist survival.

The digital age has released further the human capacity to create in networks of cooperation and solidarity. Here again, the multiplicity of our desires and our diversities is the crucial resource. Anyone who works on the internet is made aware of a creative commons that is boundless and ever-renewable. The struggle over patents, not just in the drug industry, is really a divide between our capacity to work creatively and collectively and capitalism's need to cut off a portion of that creativity for its profit.

In businesses all over the world and in the academic disciplines that serve them a new term has emerged —emotional work. Call center agents are asked to “smile down the phone”. Sales people are asked to manage the anger of customers as they protect the true owners of the large enterprises that deliver poor service or take people's homes away for the sake of the banks.

In countries like the Philippines, women have become the face of migration. More and more jobs in the productive sector can be contracted out to wherever in the world labor is cheapest. But the human body cannot yet be sent to where it must be cared for, although we are beginning to see some elements of this. So it is the women who do reproductive work who are the labor migrants more than the workers in the productive sectors. Our nurses, our caregivers, our domestic helpers and yes, even our entertainers and sex workers are the new face of our export. Governments, banks, airlines and trafficking syndicates flourish on international labor migration. It would be naïve to think that in a globalized world we could staunch the flow of nurses and caregivers in the Philippines merely by improving the jobs at home.

The neoliberal demand for the free flow of capital is matched by the demand for the control of the flows of migration. Indigenous people's are kept in their reserves. Within the country, the elite carve out enclaves for their own schools, homes and offices while workers go from work site to work site, finding short term work. Racist and elitist immigration policies in most receiving countries assure cheap and exploitable foreign labor. This is population control and it is tied up with the rhetoric of “there are just too many people” in the strange reasoning of capitalism. The arguments against migrants over and over is that they use up scarce health services and take the jobs of the locals. In the same vein, the youth are burdened by the thought that their numbers are growing too fast and that there will not be enough jobs created for them to keep them from becoming drug addicts and criminals.

The initial insight of feminists that production and reproduction are of equal importance to any society has become even more clear. The idea that we can fight our way out of this mess by liberating only the sites of production, and not reproduction, is foolish.

But if I am astounded by the capacity of some who call themselves anti-capitalist to ignore the reproductive, I am even more astounded by those working in health care to do so. But what is health care except reproduction and nurturing? What is our call for health justice except a call also for reproductive justice — of women and men in tribal areas sterilized by population control programs and the poisoning of their environment; of migrant women fighting for equal rights to health for their families; of HIV-AIDS activists who see the need to confront the norms of sexuality in order to empower women and the young towards safer sex practices; of women seeking to end the mass rape that are a part always of the dirty imperialist wars. I could go on. But my time is limited.

There is one final point I wish to make about refusing to be divided. And that is we must work to avoid funding the health care system piecemeal. We have seen how global funding for specific diseases creates further disintegration of already weak and atomized health care systems. We must instead demand that health care must reach all and most especially the most vulnerable.

Against the tyranny of governments suborned or blackmailed into ensuring an international order of capitalist accumulation, we must posit the resistive force of transnational solidarity across social movements. Against the confines of national citizenships constrained by sexual, class, caste and racial discrimination we must posit an alternative vision of global citizenship.

I am not being rhetorical here, it is time to push forward our engagements with the UN, WB, IMF, WTO, etc. We must demand that we are citizens of a single world and as such have basic minimum rights that we carry with us whether we be in Capetown or Manila. I can imagine what some of these might be. For example, freedom from torture, rape and other forms of degrading and inhumane treatment should be a right of every global citizen. Everyone should have the freedom of religion or non-belief. Perhaps those of you here already have something to add to this list. But I will add one of my own — everyone, regardless of race, caste, class, creed, ethnicity, gender identity or sexual orientation; regardless of whether we are documented citizens or undocumented visitors; should have free and comprehensive health care that includes sexual and reproductive health, wherever we may be in the world.

In yesterday's plenary we asked how we could make the transition away from capitalism. I say, win Universal Health Care Access for all, and we take a necessary if not sufficient step towards our future.

I thank you and good afternoon.

This paper was originally published by Isis International at and is reprinted here with the kind permission of Dr Sylvia Estrada Claudio.